At GCRM we offer a procedure called an ‘Endometrial Scratch’. Recent studies have suggested that the endometrial scratch may improve implantation rates in patients who have had multiple failed IVF cycles despite good quality embryos. Embryo implantation into the womb may fail due to poor embryo quality or abnormal embryo genetics. It can also often fail due to poor ‘endometrial receptivity’. This is where the lining of the womb is not favourable for the embryo to implant.
The endometrial scratch is a straightforward out-patient procedure which is relatively painless (similar to a cervical smear test). The procedure involves “scratching” the endometrial lining of the womb with a very small catheter (plastic tube) prior to an attempt to get pregnant.
The procedure is thought to increase the immune system cells and therefore the growth factors at the site of the endometrial scratch. This is believed to make the womb lining more receptive to embryo implantation. Studies have suggested that implantation rates may be twice as high in patients who have an endometrial scratch before attempting to get pregnant.
It is recommended that the endometrial scratch is performed in the cycle before you start stimulation medication. Ideally the procedure should be done between days 19 and 25 of your menstrual cycle.
In the month of your endometrial scratch you must use contraception as the scratch could compromise any natural pregnancy.
The risk of a miscarriage if you get pregnant after the procedure is no more than 1%. Given the increased chance of getting pregnant, the benefits of the procedure outweigh any risks.
You will attend the clinic with a semi-full bladder (drink 300ml of water 1 hour prior to the procedure, and do not empty your bladder during this time). First the Doctor will perform an internal ultrasound scan to assess the shape and position of the womb. A very small catheter will then be inserted through the cervix into the womb. This catheter will be used to scratch 4 areas on the womb lining. You may experience slight discomfort as the catheter is being passed into the womb.
After the procedure, a small amount of vaginal spotting or bleeding is not unusual. You can commence an IVF cycle as normal the following month or try a natural cycle in the same month.
The success of IVF depends on many events, and implantation is one of the final hurdles. For successful implantation, the embryo must escape or “hatch” out of its outer shell (the zona pellucida). Once the embryo has hatched, it can make physical contact with the lining of the womb (the endometrium) and implantation can begin. If the embryo is unable to hatch from its zona pellucida, it won’t be able to implant successfully in the wall of the uterus.
Assisted hatching is a physical or chemical treatment carried out immediately before embryo transfer. It weakens an area of the zona pellucida with the aim of improving the chances of implantation. At GCRM we use a laser, as it is considered to be the safest and most accurate method.
We’d recommend assisted hatching in patients who meet one or more of the following criteria. We’ll also consider requests from patients who don’t, on a case-by-case basis: